Amiodarone Cost Effectiveness in Preventing Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

Background The purpose of this study was to estimate the costs and health benefits of routinely administered postoperative amiodarone as prevention of atrial fibrillation for patients undergoing coronary artery bypass grafting (CABG) for stable angina. Methods This cost-effectiveness study was based on a randomized, controlled, double-blind trial (the RASCABG study) using avoidance of atrial fibrillation as the measure of benefit at the Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Skejby, Denmark. Two hundred and fifty eligible consecutively enrolled CABG patients were included to receive either 300 mg amiodarone or placebo (5% aqueous dextrose solution) administered intravenously over 20 minutes followed by 600 mg amiodarone/placebo orally twice a day (8 am and 8 pm) for the first 5 postoperative days. Results In the amiodarone group, there were 14 cases of atrial fibrillation compared with 32 in the control group (p < 0.01) whereas there were no differences in the length of stay. The mean total cost per patient was €7,639 in the amiodarone group and €7,814 in the placebo group (p < 0.01). Conclusions Routine use of postoperative prophylactic intravenous bolus and subsequent 5 days of oral amiodarone therapy after coronary artery bypass grafting reduces the risk of atrial fibrillation and decreases the total costs of care by €175 per patient.